腹水分级及非选择性β受体阻滞剂的应用对慢加急性肝衰竭1年预后的影响  

Effects of ascites grading and the application of non-selective beta-blockers on the 1-year prognosis of acute-on-chronic liver failure

作　　者：刘婉姝 申力军 贺希 田华 翟庆慧 李东泽 辛绍杰 游绍莉 Liu Wanshu;Shen Lijun;He Xi;Tian Hua;Zhai Qinghui;Li Dongze;Xin Shaojie;You Shaoli(Liver Disease Department,Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军总医院第五医学中心肝病医学部,北京100039

出　　处：《中华肝脏病杂志》2025年第1期57-62,共6页Chinese Journal of Hepatology

基　　金：“十三五”国家科技传染病重大专项(2017ZX10203201-004)。

摘　　要：目的探讨腹水分级及非选择性β受体阻滞剂(NSBBs)应用对慢加急性肝衰竭(ACLF)1年预后的影响。方法对1386例ACLF患者进行腹水分级并随访1年,使用Kaplan-Meier Log-rank检验、Cox逐步回归法进行多因素回归,分析腹水分级及NSBBs等对ACLF 1年预后的影响。计量资料组间数据比较应用t检验、Mann-Whitney U或Kruskal-Wallis检验;计数资料组间数据比较采用χ^(2)检验。结果1386例ACLF患者入院时腹水发生率为77.56%。1386例ACLF患者腹水分级1年生存曲线检验结果Log-rank(Mantel-Cox)χ^(2)=21.384,P<0.01。Cox逐步回归法进行多因素回归分析显示,腹水分级、年龄、消化道出血、肺部感染、急性肾损伤、凝血酶原活动度(PTA)、尿素、MELD-Na评分以及应用NSBBs与ACLF 1年预后密切相关。2级/3级腹水组NSBBs治疗的Log-rank(Mantel-Cox)χ^(2)=6.113,P=0.013,差异具有统计学意义。提示对有2级、3级腹水的ACLF患者,NSBBs治疗有助于提高ACLF 1年生存率。结论腹水分级以及应用NSBBs等因素影响ACLF患者1年预后;NSBBs对ACLF长期预后可能有益,ACLF发生前已经应用NSBBs的患者可以延续治疗。Objective To investigate the effects of ascites grading and the application of non-selective beta-blockers(NSBBs)on the 1-year prognosis of acute-on-chronic liver failure(ACLF).Methods 1386 ascitic cases with ACLF were graded and followed up for one year.The 1-year prognostic effect of ascites grade and NSBBs was analyzed on ACLF by the Kaplan Meier Log-rank test,Cox stepwise regression,and multivariate regression.The t-test,Mann-Whitney U,or Kruskal-Wallis test were used for intergroup comparison of measurement data.Theχ^(2) test was used for intergroup comparison of numerical data.Results The incidence rate of ascites at admission was 77.56%in 1386 ACLF cases.The Log-rank(Mantel-Cox)of the 1-year survival curve test for 1386 ACLF patients with ascites grade was 21.384,P<0.01.Multivariate regression and Cox stepwise regression analysis showed that ascites grade,age,gastrointestinal bleeding,pulmonary infection,acute kidney injury,prothrombin activity(PTA),urea,MELD-Na score,and the use of NSBBs were closely related to the 1-year prognosis of ACLF.The log rank(Mantel-Cox)of NSBBs treatment in the grade 2/3 ascites group was 6.113,P=0.013,and the difference was statistically significant,suggesting that NSBBs treatment can help improve the 1-year survival rate in ACLF patients with grade 2 and 3 ascites.Conclusions Ascites grading and the use of NSBBs affect the prognostic factor of ACLF at one year.NSBBs may be beneficial for the long-term prognosis of ACLF,and treatment can be continued in patients who have already received NSBBs prior to the onset of ACLF.

关 键 词：肝衰竭 腹水 非选择性Β受体阻滞剂 治疗 预后 

分 类 号：R575.3[医药卫生—消化系统]